Provider Demographics
NPI:1659815322
Name:SAVILLE, MARK
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:SAVILLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:86 SAULLIE EVANS DR
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:26847-7014
Mailing Address - Country:US
Mailing Address - Phone:304-851-1322
Mailing Address - Fax:
Practice Address - Street 1:86 SAULLIE EVANS DR
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26847-7014
Practice Address - Country:US
Practice Address - Phone:304-851-1322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-14
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV6655183500000X
CO16376183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist